Migraine headaches impact around a billion people globally, with many of them being individuals who could become pregnant. Interestingly, the occurrence of migraines can change during pregnancy; they might increase, decrease, or remain constant. Recently, we chatted with Jenna, who is currently five months pregnant and dealing with migraine management. She reached out to us seeking advice on treatment options for her next pregnancy. During her first pregnancy, Jenna relied on acetaminophen and sumatriptan, but over time, these medications became less effective for her. Now, she’s curious about the newer treatments available since her last pregnancy.
Jenna’s healthcare provider suggested considering options like Emgality® (galcanezumab-gnlm) or Nurtec ODT® (rimegepant). With a plethora of new medications on the market, let’s break down the latest options. These newer treatments fall under a category known as CGRP (calcitonin gene-related peptide) antagonists, which can either treat acute migraine attacks or prevent them—or sometimes do both, as is the case with the medications Jenna is interested in.
Newer Medications for Preventing Chronic Migraines
- Qulipta® (atogepant) – oral; CGRP receptor antagonist
- Ajovy® (fremanezumab-vfrm) – injection; CGRP blocker
- Vyepti® (eptinezumab-jjmr) – injection; CGRP receptor blocker
- Aimovig® (erenumab-aooe) – injection; CGRP receptor blocker
- Emgality® (galcanezumab-gnlm) – injection; CGRP blocker
- Nurtec ODT® (rimegepant) – tabs; CGRP receptor antagonist
Options for Acute Migraines
- Emgality® (galcanezumab-gnlm) – injection; CGRP blocker
- Nurtec ODT® (rimegepant) – tabs; CGRP receptor antagonist
- Ubrelvy® (ubrogepant) – oral; CGRP receptor antagonist
Unfortunately, there’s limited information on the human data for Qulipta®, Nurtec ODT®, and Ubrelvy®, making it challenging to fully assess the risks associated with these medications. However, we do have some human data on Ajovy®, Vyepti®, Aimovig®, and Emgality®, though it remains limited.
Ajovy®, for instance, has been studied with 13 exposures before pregnancy and 10 during pregnancy, with no increase in pregnancy loss noted. One case reported a child born with kidney issues, but it’s unclear if this was related to the medication. For Vyepti®, only one case during pregnancy was reported, resulting in a miscarriage, but due to the size of the molecule, significant risks during early pregnancy may be unlikely. Aimovig® has 116 reported cases, showing no increased risk of pregnancy loss or birth defects. Similarly, Emgality® has 125 cases with no reported increase in risks.
Jenna is particularly interested in both Nurtec ODT® and Emgality®, as both can treat and prevent migraines. However, we emphasized that current human studies for Nurtec ODT® are lacking, although animal data suggests low risk. The drug clears from the body quickly, allowing Jenna to potentially try it without a long wait to conceive. Emgality® looks promising based on existing data, and Jenna is keen to discuss her options with her healthcare provider.
Ultimately, tackling migraines might be a hassle, but reviewing the latest data doesn’t have to be. If you’re interested in learning more about other couples navigating similar journeys, check out this blog post about their journey after 1.5 years of trying to conceive. Also, consider looking into fertility supplements to enhance your chances of conception. For more comprehensive information, visit WomensHealth.gov for resources on pregnancy and home insemination.
In summary, while managing migraines during pregnancy can be challenging, there are newer treatment options available that warrant consideration. Stay informed and consult with healthcare professionals to find the best path forward.